Health care - administrative incompetence

[Garrison0fMars]

We also have a whole, whole lot of people who can't afford to fill their prescriptions.

This is sadly true. Not a day goes by when I walk near a pharmacy and someone is begging and crying for cash to fill their prescriptions. Whole situation makes me want to puke honestly.

 

[Mongrel]

So anybody want to make the argument that the government is more efficient in paying for healthcare?

And yet, when it's easier to streamline when everyone is entitles to the same care, there's a large list of guidelines for how to treat (whilst still allowing clinical judgement), there's a dramatic decrease of inconvenience for the patient because nearly every clinic\specialist will treat them* - so no more trips across the city because that's who your insurance deals with and drug prices are the same across the country because the government has negotiated and set prices.

* I do not know many specialists in the UK who ONLY deal in private care, nearly all work within the NHS and have private consultations as well

 

[Agatha]

Are prescriptions in the US the cost of the drug?

Here they are £7.20 per item in England (no matter what the cost of the drug to the NHS, £3 in Scotland (and will be free from April, I understand), and free in Wales and Northern Ireland.

People who are on a low income or have certain chronic conditions get their prescriptions free. Those who do need to pay can buy a prepayment certificate for £28.25 for three months or £104 for a year, and this covers all their prescriptions for that time.

 

[Garrison0fMars]

Are prescriptions in the US the cost of the drug?

Generally yeah. Differs with formula (generic, brand name) and insurance plan.

 

[xjx388]

Yes, there are. It is called 'fee for service' driven medicine rather than evidence and clinical outcomes medicine.

I can take cheap shots too . . .

But I won't.

 

[kellyb]

I can take cheap shots too . . .

But I won't.

About strep throat? No, you can't.

 

[Mongrel]

I work in healthcare and I see the overutilization first hand.

So when Ducky explains how he got shafted it's;

Yup and you're using anecdotal scare stories to argue with instead of facts.

 

[Tatyana]

I can take cheap shots too . . .

But I won't.

It isn't any different than your assertions that the NHS is not paying £ 2.40 in antibiotic costs as a 'money saving rationing'.

I have posted several articles from the New England Journal of Medicine that one of the issues with US medical costs and practice is that it is fee for service.

 

[Galteeth]

Holy crap. That is a huge difference in cost.

To clarify, that was the bill for three treatments. The bill was itemized. The cost of the actual medicine itself, for one treatment, was $23,000. The additional $2,000 per treatment was hospital related.

Still a crazy price difference. I forget what the price was when it was orignally approved by medicaid, but it wasn't 23,000!

And to further state: I am absolutely, 100 percent sure that the price per drug per infusion was 23,000. I thought it must have been a mistake when I got the bill. But no.

 

[Mongrel]

Are prescriptions in the US the cost of the drug?

Here they are £7.20 per item in England (no matter what the cost of the drug to the NHS, £3 in Scotland (and will be free from April, I understand), and free in Wales and Northern Ireland.

People who are on a low income or have certain chronic conditions get their prescriptions free. Those who do need to pay can buy a prepayment certificate for £28.25 for three months or £104 for a year, and this covers all their prescriptions for that time.

To add, due to it's Government run nature anybody can check the price of commonly dispensed drugs;
English Drug Tariff (also covers the Welsh service)
Scottish Drug Tariff
Northern Ireland Drug Tariff (currently, their website is in a state of flux at the moment)

A private prescription will cost Price of Drug\NHS price (whichever is more expensive) + VAT + % markup for the Pharmacy

 

[Agatha]

$23,000? Holy Three infusions of the drug here: cost to the NHS £1259 or about $1948, cost to the patient £0

ETA and further to Mongrel's post, you can also check drug prices in the BNF, given free to health professionals every six months and available at http://bnf.org/bnf/index.htm and downloadable on several sites. The current issue is 60, Sep 10. The paper one I have is 58 (Sep 09), my sister in law gave it to me.

 

[jimbob]

I work in healthcare and I see the overutilization first hand.

So when Ducky explains how he got shafted it's;

Yup and you're using anecdotal scare stories to argue with instead of facts.

But of course Anecdotes *are* data. You have to be careful about drawing conclusions from it but they do show how the system works in certain situations.

Of course there is some self selection but there are only about 2,000 active members on this site, and several in the US have shown how the system has failed them, in ways that wouldn't happen in other OECD countries.

xjx388, however just made a statement of opinion:

I work in healthcare and I see the overutilization first hand

There are no details in that at all. I am sure there is some overutilisation, some of it due to over testing and treatment as encouraged by the system, and discussed in this thread, and some for other reasons.

 

[Tatyana]

http://www.nejm.org/doi/full/10.1056/NEJMp1006571
Health Care Reform and Cost Control
These changes in information and infrastructure will not spontaneously affect how doctors deliver care; incentives within the system also need to be recalibrated, since the dominant fee-for-service payment system creates disincentives to making the changes necessary for coordinated care. In addition to the hospital readmission policy, the ACA will create incentives for hospitals to adopt proven practices that substantially reduce their rates of hospital-acquired infections and other avoidable conditions;

http://www.nejm.org/doi/full/10.1056/NEJMp1011712
Physicians versus Hospitals as Leaders of Accountable Care Organizations
The ACA aims to simultaneously improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness

You might be interested in this article:

http://www.nejm.org/doi/full/10.1056/NEJMp078199
Going Dutch — Managed-Competition Health Insurance in the Netherlands
Twenty-five years ago, the health care system of the Netherlands was operating under top-down cost-containment policies, such as regulation of doctors' fees and hospital budgets, that were widely criticized for lacking incentives for efficiency and innovation. In 1986, the Dekker Committee, an independent group appointed by the Dutch government to seek a solution, recommended market-oriented reform within the context of a national health insurance system. But before the concept could be implemented, a host of adequate systems had to be developed — systems of risk equalization, of product classification and medical pricing to give providers appropriate incentives for efficiency, of outcome and quality measurement to permit the development of fully specified contracts between insurers and providers and to prevent competition focused only on price, and of information sharing with consumers about the prices and quality of insurers and providers. Moreover, successful implementation required an adequate governance structure and an effective competition policy. For the next 20 years, successive governments consistently worked to realize the preconditions for managed competition.
Going Dutch — Managed-Competition Health Insurance in the Netherlands

 

[kellyb]

It isn't any different than your assertions that the NHS is not paying £ 2.40 in antibiotic costs as a 'money saving rationing'.

I have posted several articles from the New England Journal of Medicine that one of the issues with US medical costs and practice is that it is fee for service.

Our guidelines for testing for and treating GAS are actually a subject of considerable debate, because:

http://www.mayoclinicproceedings.com/content/81/9/1153.full

While not completely solvable at the clinic level, one caveat from the American Academy of Pediatrics Redbook is worth remembering: “children with manifestations highly suggestive of viral infection, such as coryza, conjunctivitis, hoarseness, cough, anterior stomatitis, discrete ulcerative lesions, or diarrhea are unlikely to have GAS as the cause of their pharyngitis and generally should not be tested for GAS.”6 A high proportion of children with positive cultures or rapid antigen detection test results in such instances are likely to be streptococcal carriers.8 Indeed, pharyngeal carriage rates of GAS in healthy children in schools and child-care centers may at times be 15% or even higher,6 and carriage of a single GAS strain may persist for many months.9

If you culture too many sore throats, you're going to be treating asymptomatic GAS carriers who simply have a viral infection causing their sore throat. Giving out too many antibiotics contributes to antibiotic resistance. Antibiotics also have risks in and of themselves. How to balance all these factors is a matter of genuine scientific debate...even in the US.

 

[Uncayimmy]

I can take cheap shots too . . .

But I won't.

So, does your clinic report statistical outcomes? If not, why not? Do you even track them? What's your flu vaccination rate? Breast cancer screening rate?

There's a weight loss clinic run by a doctor down your way. They charge $300 for the initial consultation (physical with EKG and blood work), then about $150/month thereafter for weekly weigh-ins and other stuff (I believe they opened a gym and dance studio in-house). They sell supplements they have rebranded as their own, but I couldn't find any info on what exactly they were other than sleep aids, mood aids, etc.

They deal with morbidly obese people. You've said that the only thing that works is surgery, but this clinic advises exercise and diet while prescribing Phentermine. Now, I happen to agree that diet and exercise is the best first approach. I wouldn't prescribe an appetite suppressant right off the bat, and in the UK, as I understand it, Phentermine is banned. I know of one case where this was prescribed at the first appointment at this clinic whereas the NHS recommends diet, exercise and behavior modification as a first line treatment One thing I love about the NHS system is the easy access to guidelines, such as the ones for obesity.

I would hope that under a UHC system clinics like that would be more strictly regulated when it comes to demonstrating results and using best practices. I don't like the idea of doctors rebranding supplements and selling them.

 

[Galteeth]

To clarify, that was the bill for three treatments. The bill was itemized. The cost of the actual medicine itself, for one treatment, was $23,000. The additional $2,000 per treatment was hospital related.

Still a crazy price difference. I forget what the price was when it was orignally approved by medicaid, but it wasn't 23,000!

And to further state: I am absolutely, 100 percent sure that the price per drug per infusion was 23,000. I thought it must have been a mistake when I got the bill. But no.

Also, the total i owe is 75,000 not 70,000. I was rounding down.

 

[Galteeth]

$23,000? Holy Three infusions of the drug here: cost to the NHS £1259 or about $1948, cost to the patient £0

ETA and further to Mongrel's post, you can also check drug prices in the BNF, given free to health professionals every six months and available at http://bnf.org/bnf/index.htm and downloadable on several sites. The current issue is 60, Sep 10. The paper one I have is 58 (Sep 09), my sister in law gave it to me.

I wonder what accounts for the huge price difference. It's really hard to think of an explanation for that much of a difference.

 

[xjx388]

About strep throat? No, you can't.

Sure I can, but I see little value in trading cheap shots about each other's strep throat guidelines. Talk about time wasters . . .

Surely you guys have a more substantial issue with my position than this?

 

[kellyb]

I wonder what accounts for the huge price difference. It's really hard to think of an explanation for that much of a difference.

Our entire system is completely ****'ed up.

I'm in TN, and Bill Frist owns a few hospitals and is a millionare worth $15 mil.

Too many super-wealthy and millionaire hands in the health care cookie jar perpetuating the rip-off.

 

[Tatyana]

Sure I can, but I see little value in trading cheap shots about each other's strep throat guidelines. Talk about time wasters . . .

Surely you guys have a more substantial issue with my position than this?

You were so sure it was a rationing, cost-saving, bad medical practice.

It is a tad gleeful that are pursuing the issue, however, it is so rare that a single point is conceded, and the goalposts have shifted.